LMN Facial Palsy in Pregnancy: An Opportunity to Predict Preeclampsia—Report and Review

Facial paralysis is the most frequent unilateral cranial nerve pathology affecting pregnant population 2 to 4 times more often than the nonpregnant population. There exists an association with preeclampsia but this has largely been overlooked. Clinicians often dismiss it for idiopathic palsy as seen in the present case. A 30-year-old woman, Gravida 4, Para 3, presented at 26 weeks pregnancy with complaints of facial weakness, blurring of vision, altered taste sensation, increased noise sensitivity for 1 month, headache since 18 days, and vomiting since 2-3 days. Her pulse was 90/min, BP was 170/120, and RR was 18/min. Uterus was 18 weeks size and proteinuria++ was present. Ultrasonography revealed a 26 weeks fetus, severe bradycardia, and absent liquor. HELLP syndrome was diagnosed after investigations. Six units of fresh frozen plasma were transfused. An informed decision for termination of pregnancy was made. She delivered a 450？gram stillborn. The third stage was complicated with postpartum hemorrhage but it was managed successfully. Women with Bell’s palsy during pregnancy should be evaluated critically as in some it may precede preeclampsia which has serious maternal and fetal implications. Therefore, these women should be in regular followup of the obstetrician. 1. Introduction Facial paralysis is an entity that most neurologists and otolaryngologists are familiar with. It is the most common and frequent unilateral cranial nerve pathology. Most commonly it is idiopathic or Bell’s palsy named after Sir Charles Bell who first described this condition and also its association with pregnancy [1]. Bell’s palsy is also associated with preeclampsia but this has been overlooked in the past. The patients have not been followed by the neurologists for such an event. The obstetricians, who often recognize central facial paralysis in severe preeclampsia as a part of stroke, have failed to relate peripheral facial palsy to preeclampsia only to dismiss it for idiopathic palsy as seen in the present case. 2. Case A 30-year-old, gravida 4, para 3, woman presented in antenatal outpatient department (OPD) at 26 weeks pregnancy with complaints of facial weakness, blurring of vision, altered taste sensation, and increased noise sensitivity for 1 month. She had headache since 18 days and vomiting since 2-3 days. All her previous deliveries were at home. In her last delivery at term, she had a stillborn baby. The present case was diagnosed with hypertension when she was three months pregnant and took prescribed antihypertensive drugs for about two months. About twenty